The Flipped Classroom Model in Infectious Disease Nursing: Implementation and Assessment of Educational Effectiveness (FC)

September 2, 2026 updated by: Dangui Zhang, Shantou University Medical College

The goal of this retrospective cohort study was to evaluate whether the flipped classroom (FC) teaching model improved academic performance and student engagement in an integrative Infectious Disease Nursing course, compared with traditional lecture-based instruction. The main questions it aimed to answer were:

  1. Did the flipped classroom model produce higher final examination scores than traditional lectures after adjusting for students' prior academic achievement?
  2. Did the flipped classroom model enhance students' self-reported course interest and engagement?
  3. How did prerequisite course performances contribute to final achievement in this integrative nursing course? Researchers compared undergraduate nursing students taught via the flipped classroom in the 2024-2025 academic year (n = 18) with historical controls who received lecture-based instruction in the 2023 academic year (n = 36) at a single university in China.

Participants in the flipped classroom group (2024-2025 cohort):

  1. Completed weekly pre-class preparation modules (e.g., reviewing recorded lectures, reading assignments) before each session
  2. Attended in-class sessions that emphasized student-led presentations and case-based group discussions
  3. Completed a final written examination covering integrative Infectious Disease Nursing content
  4. Provided anonymous feedback ratings on their course interest and overall learning experience The historical control group (2023 cohort) received traditional lecture-based instruction and completed the same final examination and feedback survey.

Study Overview

Status

Status

Indicates the current recruitment status or the expanded access status.
Completed

Conditions

Conditions

The disease, disorder, syndrome, illness, or injury that is being studied. On ClinicalTrials.gov, conditions may also include other health-related issues, such as lifespan, quality of life, and health risks.

Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.

Detailed Description

This is a single-center, retrospective cohort study designed to evaluate the effectiveness of the flipped classroom (FC) teaching model compared with traditional lecture-based instruction in an integrative Infectious Disease Nursing course.

The study was conducted at Shantou University Medical College, China. Undergraduate nursing students enrolled in the Infectious Disease Nursing course during the 2024-2025 academic year (the FC cohort, n = 18) were compared with historical controls who received lecture-based instruction during the 2023 academic year (the control cohort, n = 36). All participants were from the same instructional track and completed the same course requirements.

For the FC cohort, the instructional design consisted of weekly modules that required students to complete pre-class preparation activities, including reviewing recorded educational videos and assigned readings. In-class sessions were structured around student-led presentations and case-based group discussions to reinforce the pre-class content. The historical control cohort received conventional teacher-centered lectures covering the same course content during the 2023 academic year.

Data were extracted retrospectively from existing academic records and course evaluation databases. The primary outcome measure was final examination score, which consisted of multiple-choice questions and open-questions covering integrative Infectious Disease Nursing content. Secondary outcome measures included gain scores (calculated as final examination score minus the average prerequisite course score) and course feedback ratings on student interest and overall learning experience.

Statistical analyses were performed using SPSS 30.0 and Python 3. Group differences in continuous variables were compared using independent-samples t-tests. Partial correlation analysis was conducted to examine the independent contributions of prerequisite course performances to Infectious Disease Nursing achievement. Analysis of covariance (ANCOVA), with gain score as a covariate, was used to evaluate the independent effect of the FC model after adjusting for prior academic achievement. All statistical tests were two-sided, with a significance level set at P < 0.05.

Because this study was retrospective in nature and involved analysis of existing educational records, no study intervention was assigned as part of the protocol. The study was conducted in accordance with the Declaration of Helsinki and received ethical approval from the Ethics Committee of Shantou University Medical College (Approval No.: SUMC-2026-013).

Study Type

Study Type

Describes the nature of a clinical study. Study types include interventional studies (also called clinical trials), observational studies (including patient registries), and expanded access.
Observational

Enrollment (Actual)

Enrollment

The number of participants in a clinical study. The "anticipated" enrollment is the target number of participants that the researchers need for the study.
54

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • China
    • Guangdong
      • Shantou, Guangdong, China, 515041
        • Shantou University Medical College

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Eligibility Criteria

The key requirements that people who want to participate in a clinical study must meet or the characteristics they must have. Eligibility criteria consist of both inclusion criteria (which are required for a person to participate in the study) and exclusion criteria (which prevent a person from participating). Types of eligibility criteria include whether a study accepts healthy volunteers, has age or age group requirements, or is limited by sex.

Ages Eligible for Study

  • Child
  • Adult
  • Older Adult

Accepts Healthy Volunteers

Yes

Sampling Method

Non-Probability Sample

Study Population

All students in the 2021, 2022, and 2023 cohorts who completed the course of Infectious Diseases Nursing (IN) were eligible.

Description

Inclusion Criteria:

  • documented grades in both prerequisite courses (Microbiology & Immunology and Adults Nursing) AND
  • completion of the final examination

Exclusion Criteria:

  • incomplete prerequisite records OR
  • withdrawal from the course

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

Cohorts and Interventions

Group / Cohort

Group / Cohort

A group or subgroup of participants in an observational study that is assessed for biomedical or health outcomes.
Intervention / Treatment

Intervention / Treatment

A process or action that is the focus of a clinical study. Interventions include drugs, medical devices, procedures, vaccines, and other products that are either investigational or already available. Interventions can also include noninvasive approaches, such as education or modifying diet and exercise.
Historical Control Group (Traditional Lecture)
This group consisted of undergraduate nursing students enrolled in the Infectious Disease Nursing course during the 2023 academic year. Participants received traditional lecture-based instruction delivered in a teacher-centered format. Course content covered the same integrative Infectious Disease Nursing curriculum. Data were extracted retrospectively from existing academic records, including final examination scores, prerequisite course averages, and course feedback ratings.
Flipped Classroom Group
This group consisted of undergraduate nursing students enrolled in the Infectious Disease Nursing course during the 2024-2025 academic year. Participants received instruction via the flipped classroom model. The instructional design comprised weekly modules requiring students to complete pre-class preparation activities, followed by in-class sessions emphasizing student-led presentations and case-based group discussions. Data were extracted retrospectively from existing academic records, including final examination scores, prerequisite course averages, and course feedback ratings.
Other: Flipped Classroom (FC) as the teaching mode
The FC comprised seven weekly modules. Pre-class: (a) guided readings (textbook chapters, articles, 15-20-min videos on epidemiology, pathophysiology, clinical manifestations); (b) independent PubMed search summarizing ≥5 relevant articles; (c) knowledge-synthesis worksheet identifying microbiological mechanisms (pathogen traits, transmission, virulence), immune responses, Nursing Care Plan (NCP) components from prerequisite Adults Nursing (AN), and transmission-based precautions. In-class (90 min/week, small groups): student presentations (30 min, groups of 2-3 linking mechanisms, NCP, precautions); case discussions (20 min); facilitator feedback and misconception correction (30 min); peer feedback (10 min on integration quality and evidence). Post-class: reflective prompts on challenging integration aspects and knowledge gaps.

What is the study measuring?

Primary Outcome Measures

Primary Outcome Measures

In a clinical study's protocol, the planned outcome measure that is the most important for evaluating the effect of an intervention/treatment. Most clinical studies have one primary outcome measure, but some have more than one.
Outcome Measure
Measure Description
Time Frame
Final examination score
Time Frame: At the end of the semester, approximately 12 weeks after course commencement
All students completed the same final examination (100 points), consisting of three item types: knowledge recall items (30 points; A1-type multiple-choice questions on disease characteristics, transmission routes, and precaution protocols), clinical application items (40 points; A3-type multiple-choice questions presenting clinical case scenarios requiring cross-disciplinary synthesis and clinical judgment), and integrated case analysis items (30 points; case-based items requiring integration of microbiological knowledge, NCP (Nursing Care Plan) frameworks, and precaution decisions for complex patient scenarios). All responses were scored by the automated examination system, and a research assistant independently verified the scoring of all answer sheets against the system output; no discrepancies were detected.
At the end of the semester, approximately 12 weeks after course commencement
Gain score
Time Frame: At the end of the semester, approximately 12 weeks after course commencement
To index knowledge integration relative to each student's own starting point, a gain score was computed: examination score minus the mean of the two prerequisite course scores. Positive gain scores indicate performance above one's prerequisite baseline.
At the end of the semester, approximately 12 weeks after course commencement

Secondary Outcome Measures

Secondary Outcome Measures

In a clinical study's protocol, a planned outcome measure that is not as important as the primary outcome measure for evaluating the effect of an intervention but is still of interest. Most clinical studies have more than one secondary outcome measure.
Outcome Measure
Measure Description
Time Frame
Course feedback
Time Frame: At the end of the semester, approximately 11 weeks after course commencement
A post-course survey administered in the final week measured three dimensions on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree): interestingness, understanding, and overall effectiveness. One open-ended question invited suggestions for improving the course.
At the end of the semester, approximately 11 weeks after course commencement

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Sponsor

The organization or person who initiates the study and who has authority and control over the study.
Shantou University Medical College

Collaborators

Collaborators

An organization other than the sponsor that provides support for a clinical study. This support may include activities related to funding, design, implementation, data analysis, or reporting.
Second Affiliated Hospital of Shantou University Medical College

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

Study Start

The actual date on which the first participant was enrolled in a clinical study. The "anticipated" study start date is the date that the researchers think will be the study start date.
May 1, 2026

Primary Completion (Actual)

Primary Completion

The date on which the last participant in a clinical study was examined or received an intervention to collect final data for the primary outcome measure. Whether the clinical study ended according to the protocol or was terminated does not affect this date. For clinical studies with more than one primary outcome measure with different completion dates, this term refers to the date on which data collection is completed for all the primary outcome measures. The "anticipated" primary completion date is the date that the researchers think will be the primary completion date for the study.
August 20, 2026

Study Completion (Actual)

Study Completion

The date on which the last participant in a clinical study was examined or received an intervention/treatment to collect final data for the primary outcome measures, secondary outcome measures, and adverse events (that is, the last participant's last visit). The "anticipated" study completion date is the date that the researchers think will be the study completion date.
August 20, 2026

Study Registration Dates

First Submitted

First Submitted

The date on which the study sponsor or investigator first submitted a study record to ClinicalTrials.gov. There is typically a delay of a few days between the first submitted date and the record's availability on ClinicalTrials.gov (the first posted date).
September 2, 2026

First Submitted That Met QC Criteria

First Submitted That Met QC Criteria

The date on which the study sponsor or investigator first submits a study record that is consistent with National Library of Medicine (NLM) quality control (QC) review criteria. The sponsor or investigator may need to revise and submit a study record one or more times before NLM's QC review criteria are met. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 2, 2026

First Posted (Actual)

First Posted

The date on which the study record was first available on ClinicalTrials.gov after National Library of Medicine (NLM) quality control (QC) review has concluded. There is typically a delay of a few days between the date the study sponsor or investigator submitted the study record and the first posted date.
September 8, 2026

Study Record Updates

Last Update Posted (Actual)

Last Update Posted

The most recent date on which changes to a study record were made available on ClinicalTrials.gov. There may be a delay between when the changes were submitted to ClinicalTrials.gov by the study's sponsor or investigator (the last update submitted date) and the last update posted date.
September 8, 2026

Last Update Submitted That Met QC Criteria

Last Update Submitted That Met QC Criteria

The most recent date on which the study sponsor or investigator submitted changes to a study record that are consistent with National Library of Medicine (NLM) quality control (QC) review criteria. It is the responsibility of the sponsor or investigator to ensure that the study record is consistent with the NLM QC review criteria.
September 2, 2026

Last Verified

Last Verified

The most recent date on which the study sponsor or investigator confirmed the information about a clinical study on ClinicalTrials.gov as accurate and current. If a study with a recruitment status of recruiting; not yet recruiting; or active, not recruiting has not been confirmed within the past 2 years, the study's recruitment status is shown as unknown.
September 1, 2026

More Information

Terms related to this study

Keywords

Other Study ID Numbers

Other Study ID Numbers

Identifiers or ID numbers other than the NCT number that are assigned to a clinical study by the study's sponsor, funders, or others. These numbers may include unique identifiers from other trial registries and National Institutes of Health grant numbers.
  • SUMC-2026-013

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

IPD Plan Description

The data are not publicly available due to ethical restrictions (student academic records; the ethics approval did not include public deposition).

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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